Pediatric inguinal hernia is a congenital disease with about 20,000 cases reported in Japan each year, making it one of the most common diseases in pediatric surgery. In healthy boys, as the testes descend into the scrotum at birth, the peritoneum is drawn in along with the testes to forma sac within the scrotum. As the testes reach the scrotum, however, the sac formed by the peritoneum will be spontaneously closed. In the event that the sac-like peritoneum (i. e., hernia sac) is not closed and maintained, the intestine and other abdominal tissue may eventually enter the hernia sac. The condition is referred to as pediatric inguinal hernia. In girls, the round ligament of uterus extends from the upper lateral sides of uterus and follows the same path as the descending path of the testicles to hold the uterus in place. The ligament descends with a protrusion in the peritoneum, which, if not closed, forms a hernia sac.
The pediatric inguinal hernia is typically treated by surgical procedures involving ligation of the hernia sac at its neck (i.e., hernia orifice) using a suture. Two types of surgical procedures are used to treat pediatric inguinal hernia: open surgery and laparoscopic surgery. An open surgery is performed by incising the skin in the groin to pull out the hernia sac, and ligating the sac in the proximity of the hernia orifice. Involving incision in the groin, the open surgery tends to leave scars and cause significant post-surgical pain.
In contrast, a laparoscopic surgery, such as a technique known as laparoscopic percutaneous extraperitoneal closure (LPEC), is performed by inserting a laparoscope (i. e., camera) through a small opening formed in the umbilicus, and suture-ligating the vicinity of the hernia orifice using a surgical instrument while viewing the inside of the abdominal cavity on a monitor screen. As described, the LPEC technique is a less-invasive procedure that can eliminate the issues of scar formation and post-surgical pain associated with open surgery.
Known surgical instruments used in LPEC include a suture guide needle called Lapa-Her Closure™ as described in Non-Patent Document 1 (the entire disclosure of which is incorporated herein by reference) listed below.